The Influence of Medical and Nonmedical Factors to the Progression of Renal Osteodystrophy

We report a 13-year-old boy hospitalized for the first time at the age of 17 months with clinical and laboratory signs of chronic kidney disease (CKD) and renal osteodystrophy caused by severe obstructive uropathy of the single kidney. Prevention and treatment of renal osteodystrophy has been target for aggressive therapy and the great challenge for pediatric nephrologists. The outcome of the therapy of renal osteodystrophy is influenced by medical and non – medical factors. It was concluded that the place of living (in our example a small village distant from primary care physicians, far from the social care professionals and far from the hospital), inferior social and economical status with inadequate nutrition present negative factors that contributed to the outcome and development of CKD and its complications as is renal osteodystrohy. The coordination of medical and non – medical professionals is necessary on the primary and secondary level to achieve positive results of therapy in patients with CKD

Vaccination and communication

Cijepljenje je najdjelotvornija metoda u prevenciji zaraznih bolesti, projekt javnog zdravstva prošlog stoljeća koji je spasio dva do tri milijuna djece godišnje diljem svijeta. Iako je cijepljenje zakonski obvezno u velikom broju zemalja i unatoč evidentnim epidemiološkim pokazateljima djelotvornosti cjepiva koji se očituju u znatno manjoj incidenciji preventibilnih dječjih zaraznih bolesti (eradikacija velikih boginja, eradikacija polia u velikom dijelu svijeta), sve je veći broj roditelja koji odbijaju cijepljenje svojeg djeteta što je rezultiralo porastom broja necijepljene djece i pojavom većih ili manjih epidemija preventibilnih dječjih zaraznih bolesti. Razlog sve većeg broja necijepljene djece može se naći u strahu roditelja od nuspojava cjepiva i sumnji u djelotvornost cijepljenja, neadekvatnoj komunikaciji sa zdravstvenim djelatnicima i priklanjanju dobivanja informacija od strane antivakcinalnih pokreta. Roditelji mogu dobiti informacije iz različitih izvora: od djelatnika javnog zdravstva, pedijatara i drugih zdravstvenih radnika koji rade s djecom, članova obitelji, prijatelja, medija (tiskovnih, TV), blogova, različitih internetskih izvora, interesnih skupina i udruga, antivakcinalnih pokreta. Prema recentnim istraživanjima, liječnici su još uvijek preferirani izvor informacija od kojeg roditelji žele dobiti informaciju o cijepljenju. Iz tog razloga dužnost je liječnika poznavati moguće modele komunikacije kako bi mogao pružati kvalitetnu informaciju vezanu uz cijepljenje. U ovom radu navedeno je nekoliko mogućih pristupa i načina komunikacije liječnika s roditeljima djece koja se cijepe. Analizom literature došli smo do saznanja kako nema jedinstvenog, standardiziranog načina komunikacije s roditeljima koji odbijaju cijepljenje. Svaki liječnik,poznavajući temelje komunikacijskih modela i pristupa, modelirat će svoj pristup ovisno o situaciji i sugovorniku.Vaccination is one of the most effective methods in the prevention of infectious diseases, the last century public health project which accounts for the prevention of 2 to 3 million deaths in children each year worldwide. Despite the fact that vaccination is mandatory in great number of countries and despite the evident epidemiological data that indicate the effectiveness of vaccination which is reflected in the significantly lower incidence of preventable childhood infectious diseases (eradication of smallpox, eradication of polio in the most countries of the world), there is an increasing number of parents who refuse to vaccinate their child which results in increased number of unvaccinated children and occurrence of greater or smaller epidemic of preventable childhood diseases. The reason for increased number of unvaccinated children could be explained by the parents fear of vaccine side effects and by doubts in the effectiveness of vaccination, the inadequate communication with health care workers and wish to receive information from anti vaccination movements. The parents could receive the information from different sources: from public health employers, from the family members, from friends, media, blogs, different Internet sources, and from Internet social network, from different interest groups and from anti-vaccine movements. According to the recent resources, the physicians are still the most preferable source of information from whom the parents want to receive the information about the vaccination. Therefore, the duty of physicians is to know the possible models of communication in order to provide the qualitative information regarding the vaccination. In this paper several possible approaches and communication methods between doctors and parents are mentioned. Analyzing the literature, we have found out that there is no unique and standardized way of communication with vaccine-hesitant parents. Every physician should develop his or her way of communication regarding the situation and interlocutor, knowing the basic communication models and approaches

The Importance of the Assessment of Quality of Life in Glaucoma Patients

Glaucoma is a chronic, progressive eye disorder that can lead to visual impairment and blindness. The projection of glaucoma prevalence in the world suggests that in 2020, 79,6 million of people will have glaucoma, 11,2 million of them will be bilaterally blind. The chronic disease, such as glaucoma, affects the different roles of a patient in everyday life and his/her well-being. Quality of Life (QoL) helps to define the inability of performing specific task that is most important to patient. Patients’ perspective on their visual impairment and well-being are essential in the planning of management of glaucoma. The assessment of QoL should be standard procedure in the management of glaucoma patients. In clinical practice it should represent a gold standard in the care of chronic patients and a proof of fulfilling the patients’ rights. The assessments of QoL should serve as a tool for good clinical practice, for respecting the patients’ rights, and respect for the value of human life in general

The influence of erythropoietin treatment on oxidative stress parameters in cortex of rats exposed to transient middle cerebral artery occlusion

Background and Purpose: Erythropoietin (Epo) plays a central role in process of erythropoiesis. Recently, its neuroprotective potential was reported in various experimental models of brain damage. However, the mechanism of Epo protection is still unclear. In the present study, we examined the effect of Epo administration on lipid peroxidation levels and antioxidant enzymes’ (superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)) activities in rat cortex following focal cerebral ischemia. Material and Methods: Focal cerebral ischemia was induced in male HanoverWistar rats (250–350 g) by right middle cerebral artery occlusion (MCAO) model for 1 hr. After 23 hrs of reperfusion, ischemic animals were sacrificed and the levels of lipid peroxidation, SOD and GSH-Px activities were determined spectrophotometrically in the right cortex. Ischemic animals received either vehicle or Epo (5000 IU/kg, intraperitoneally) immediately or 3 hrs after MCAO, and were sacrificed 23 hrs or 21 hrs later, respectively. Sham operated, vehicle treated animals served as the control group. Results and Conclusion: Focal cerebral ischemia significantly increased the level of oxidative lipid damage parameters in the right cortex as compared to the control group without affecting SOD and GSH-Px activities. The decrease in level of lipid peroxidation after Epo treatment was registered but it was not statistically significant. Our results indicate that focal cerebral ischemia caused neuronal damage in the right cortex and that Epo treatment was not effective in preventing above mentioned alteration

The influence of erythropoietin treatment on oxidative stress parameters in cortex of rats exposed to transient middle cerebral artery occlusion

Background and Purpose: Erythropoietin (Epo) plays a central role in process of erythropoiesis. Recently, its neuroprotective potential was reported in various experimental models of brain damage. However, the mechanism of Epo protection is still unclear. In the present study, we examined the effect of Epo administration on lipid peroxidation levels and antioxidant enzymes’ (superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)) activities in rat cortex following focal cerebral ischemia. Material and Methods: Focal cerebral ischemia was induced in male HanoverWistar rats (250–350 g) by right middle cerebral artery occlusion (MCAO) model for 1 hr. After 23 hrs of reperfusion, ischemic animals were sacrificed and the levels of lipid peroxidation, SOD and GSH-Px activities were determined spectrophotometrically in the right cortex. Ischemic animals received either vehicle or Epo (5000 IU/kg, intraperitoneally) immediately or 3 hrs after MCAO, and were sacrificed 23 hrs or 21 hrs later, respectively. Sham operated, vehicle treated animals served as the control group. Results and Conclusion: Focal cerebral ischemia significantly increased the level of oxidative lipid damage parameters in the right cortex as compared to the control group without affecting SOD and GSH-Px activities. The decrease in level of lipid peroxidation after Epo treatment was registered but it was not statistically significant. Our results indicate that focal cerebral ischemia caused neuronal damage in the right cortex and that Epo treatment was not effective in preventing above mentioned alteration

UNESCO, bioethics and child

Pod okriljem UNESCO-a su donese tri glavne međunarodne deklaracije iz područja bioetike s ciljem zaštite »prirodnog dostojanstva, jednakih i neotuđivih prava svih članova ljudske obitelji«. Djeca su posebno osjetljiva kategorija »ljudske obitelji« čija su se prava pokušala zaštiti donijetim deklaracijama, bilo na direktan ili indirektan način, počevši od Opće deklaracije o ljudskim pravima. Prošlo je dvadeset godina nakon donošenja »Konvencija ujedinjenih naroda o pravima djece« (20. studeni, 1989.). U ovom ćemo se radu osvrnuti na temeljna prava djeteta prema UNESCO-vim dokumentima.UNESCO has adopted three principal international bioethics declarations with the purpose to protect »the inherent dignity of the equal and inalienable rights of all members of the human family«. Children are a particularly sensitive category of the »human family« whose rights were attempted to be protected through declarations, directly or indirectly, starting with the Universal Declarations on Human Rights. It has been twenty years since adopting the »Convention on the Rights of the Child« by the UN (20 November 1989). Th is paper shall look into the basic rights of the child in accordance with UNESCO’s documents

Croatian Children’s Views towards Importance of Health Care Information

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children »Completely agreed« (92.7%) with the statement »When I am sick, I should receive information about my health« in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children’s expectation

HETERO- / AUTONOMY IN THE CONTEXT OF SELF/DETERMINISM OF BIOLOGICAL TESTAMENTS

Suvremeni pogled na umiranje obilježen je nizom neizvjesnih i teških pitanja koja proizlaze iz kliničkoga konteksta, pravne i bioetičke domene donošenja teških egzistencijalnih odluka vezanih uz posljednje životne trenutke, a napose s obzirom na medicinske intervencije izbora “skrbi na kraju života”. Taj korak zahtijeva punu racionalnost slobodne autonomije, koja u određenim trenucima može biti znatno narušena gubitkom fizičkih i/li mentalnih sposobnosti, uvjetovanih pojedinim bolestima. Stoga bi bolesnici trebali imati zakonodavnu mogućnost jasno priopćiti svoje želje u vezi sa zahtijevanim tretmanom ili njegovim distanazijskim povlačenjem u unaprijed pripremljenim smjernicama anticipiranih medicinskih odredbi bioloških oporuka za (ne)postupanje ili imenovanje surogatnog opunomoćenika kao zastupnika u (ne)izboru liječenja u slučaju ograničene sposobnosti odlučivanja. Potpisana biološka oporuka mogla bi uvelike pridonijeti pozitivno dostojanstvenijom modusu samodeterminiranog načina umiranja, poštujući “kulturu života”, sukladnog onom koji je odabir autonomnih pacijentovih vrijednosti skrbi na kraju života, koji često mogu ući u koliziju iz heteronomne perspektive surogatnih odlučitelja. Biološkim bi se oporukama višestruko nadvladale i teškoće kliničkih dilema egzistencijalnih odluka: liječnicima bi se olakšao odabir skrbi u hitnim planovima zdravstvene njege u kriznim situacijama; pacijentima bi pružale jamstvo provedbe njihova samoodređenja; dok bi surogatne odlučitelje uvelike oslobodili pritiska odgovornosti.A contemporary view of death is characterized by a sequence of uncertain and difficult questions arising from the clinical context, out of the legal and bioethical domains of taking difficult existential decisions related to the last moments of human life. This step requires a full rationality of free autonomy, which can be significantly disturbed by the loss of mental ability, conditioned by certain illnesses in certain moments. Therefore, patients should have a legislative opportunity to clearly state their wishes regarding the required treatment or the withdrawal in previously prepared guidelines of anticipated medical dispositions of the biological testaments for (non) treatment or the appointment of a surrogate representative of treatment choice at the terminal phase, in case of limited decision-making ability. The signed biological will could greatly contribute to a dignified mode of dying, consistent with the choice of autonomous patient’s end-of-life care values, which can often enter into collision from a heteronomous perspective of a surrogate decision-maker. With the biological will we could overwhelmingly overcome the difficulties of the clinical dilemma of existential decisions: Physicians would be more reliant on choosing care in urgent health care plans in crisis situations, the patients could provide the assurance of their self-determination while the surrogate rulers could be largely released from the pressure of responsibilit